Fat, Fate, and Disease : Why we are losing the war against obesity and chronic disease
Read Fat, Fate, and Disease : Why we are losing the war against obesity and chronic disease Online
Authors: Mark Hanson Peter Gluckman
FAT, FATE, AND DISEASE
Why exercise and diet are not enough
PETER GLUCKMAN & MARK HANSON
Great Clarendon Street, Oxford ox2 6
DP
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ISBN 978–0–19–964462–9
1 3 5 7 9 10 8 6 4 2
7 The Child is Father to the Man
13 Seeing and Believing: The Fat Emperor Has No Clothes
Our professional lives have been occupied with the study of development in early life, both before and after birth, and of how different patterns of development affect our health in both the short and the long term. Our research has focused not just on the mechanisms underlying these relationships, but also on the larger question of
why
our early development is so plastic. The implications of this research for understanding the human condition are substantial. As our research progressed, we thought increasingly about the mismatch between the way evolution has moulded our biology and the world we have created. Our fundamental biology appears to be at odds with our contemporary world. Although both are parts of our ‘normal’ lives, they have consequences which are reflected in the growing burden of the so-called non-communicable diseases—especially diabetes, cardiovascular disease, and the associated condition of obesity.
As we talked these ideas over, we realized that they were not widely appreciated, and were not incorporated into current strategies to reduce the burden of non-communicable diseases. In fact the reverse seemed to be true—the relevance of early developmental life to the risk of later disease seemed to be side-lined, just as developmental biology had been in biological and medical science for much of the 20th century. In addition, despite the fact that current strategies to reduce non-communicable disease met with limited success in many situations, there appeared to be a stubborn adherence to an inappropriate medical model of these diseases,
as if we were viewing them in the same way as infectious diseases. The strategy seemed to be directed at treating those adults who already have the disease—at least in societies where such treatment can be afforded—and trying to isolate individuals from the causative agents, namely smoking, dietary sugar, salt and fat, and sedentary behaviour.
For despite all the efforts of public health and of medical science to promote healthy lifestyles, the problems of diabetes, heart disease, and obesity continue to grow. Similar trends exist for some allergic and immune disorders and lung disease. The Western world gets fatter and the diet industry richer. And now the problem is exploding in the developing world too—there are hundreds of millions of people who now have diabetes or heart disease, even though many of them are not obese by Western standards. Many of them are young adults, although traditionally these are diseases of middle age. But it is also apparent, as we look at developing countries, that the solution requires attention from not just a medical perspective but a much broader developmental agenda. The more we thought about this, the more we realized that clearly something is missing from our strategy, because we are not winning the war against these diseases.
We started to communicate our concerns about this omission in lectures at conferences and in academic articles. Some of our scientific colleagues welcomed the intercession, others seemed uninterested or even resistant. The more we pursued the implications of the ideas, the more we felt the presence of vested interests in various forms, which operated to limit their inclusion in current strategy formation. What seemed increasingly obvious to us was sometimes met with denial as well as incomprehension. We began to feel like the little boy who cried ‘The emperor has no clothes!’ His statement of what everyone knew but did not want to admit produced a social change, although not so much through a direct effect on the emperor’s deceitful
courtiers as from the public reaction which followed his outburst. This book is our cry.
Given the many years and the multiple dimensions of our research, there are many people who have wittingly or unwittingly influenced our thinking. Many of them encouraged us in pursuing what was clearly an unpopular set of ideas. First we must acknowledge the colleagues, research fellows, and students with whom we have worked most recently, including Alan Beedle, Tatjana Buklijas, Felicia Low, Mark Vickers, Deb Sloboda, Tony Pleasants, Wayne Cutfield, Allan Sheppard (Auckland); Chong Yap Seng, Michael Meaney, Ravi Khambadur, Melvin Leow, Lee Yung Seng, Emilia Tng, Tai E. Shyong (Singapore); Keith Godfrey, Cyrus Cooper, Karen Lillycrop, Graham Burdge, Philip Calder, Christopher Byrne, Lucy Green, Kirsten Poore, Felino Cagampang, Rohan Lewis, Christopher Torrens, Geraldine Clough, Hazel Inskip, Caroline Fall, Nick Harvey, Aven Ahie-Sayer, Richard Oreffo, Kim Bruce, Jane Cleal, Sîan Robinson, Elaine Dennison (Southampton). Felicia and Tatjana also helped with some research for the manuscript.
We are very grateful to Terrence Forrester in Jamaica, Ronald Ma in Hong Kong, Alex Ferraro in Sao Paolo, Huixia Yang in Beijing, Tony Duan in Shanghai, Torvid Kiserud in Bergen and Ethiopia, Guttorm Haugen in Oslo, John Newnham in Perth, Australia, Anibal Llanos in Santiago de Chile, and Carlos Blanco in Dublin for their collegiality and scientific insights and for giving us important perspectives into problems in parts of the world they know well.
We have had informal discussions with many colleagues including Steve Simpson (Sydney), David Raubenheimer (Auckland), Paul Zimmet (Melbourne), John Funder (Melbourne), Pat Bateson (Cambridge), Randy Nesse (Ann Arbor), Carl Bergstrom (Seattle), Craig Rubens (Seattle), Hamish Spencer and Peter Dearden (Otago), James Heckman and Chris Kuzawa (Chicago), Tessa Roseboom (Amsterdam), and several scientists active in the nutrition and pharmaceutical industries.
We are indebted to Jane Kitcher (Southampton) and Megan Jeffries (Auckland), who cheerfully produced corrected versions of the book
throughout its gestation, often at short notice. This is the fourth book we have written together, and yet again we thank our families for their forbearance in putting up with our distracted behaviour and frequent absences.
Peter Gluckman and Mark Hanson
Auckland, Southampton, and places in between
May 2011
Blinkers and Biases
What seems to be the problem?
Only 2,000 years ago our planet housed fewer than 300 million people, 100 years ago it was home to 1.5 billion, and now there are about seven billion of us. And we will potentially add at least another two billion to the world population over the next 40 years. Most of that growth will occur in the developing and least developed world, where much of the population is young, compared with the ageing populations of the developed world. For the first time in our history more than half of us live in cities rather than in rural areas and this shift to urban living is set to go on increasing. There is massive economic productivity and continuing growth in the world, even though it has stumbled a little in the past few years, but many of us are still incredibly poor—living on less than US$1 a day—and this number will increase too. From the lowest-income societies to the vast developing economies such as India and China, we are seeing enormous social
changes. Along with economic development a big change is taking place in what people eat and how they live their lives.
All these global inhabitants will have to be fed and need access to safer food and clean water, hygienic living conditions, and a supply of energy. Energy supplies drive economic growth and we have become increasingly concerned about where that energy is going to come from in the near future. Our reliance on fossil fuels such as coal and oil leads to greenhouse gas emissions, as do the destruction of forests and the expansion of agriculture needed to sustain our expanding population. And so the world heats up.
This crisis of depletion of non-renewable energy supplies, of climate change, of degrading and uncertain water supplies, and of growing insecurity in the world’s food supply has been called ‘the perfect storm’ by the UK government’s chief scientist Sir John Beddington. This storm is a direct result of the ever-increasing number of humans living on a planet which does not have infinite resources: a population increase which in turn reflects the many ways in which we humans have changed our world.
Many of us are becoming increasingly concerned about how we can survive this storm, at least with a way of life which meets our aspirations and expectations. This issue of the quality of life for all of us forms the backdrop for this book, but our concerns extend much further than that. We have changed the planet, but we have also changed ourselves—not in the fundamental biological processes that make our bodies work, because they took millions of years to evolve and so cannot change quickly, but we have dramatically changed what we eat, the way we work, the way we expend energy, and the very pattern of our lives. More and more of us use cars instead of walking to get around; we work at a keyboard rather than at hard manual labour; and we live much longer lives than our ancestors. Many of us have smaller families
and, at least in the West, many women have their first baby at a much older age than their grandmothers or even their mothers.